Recognition
- Cutaneous: Pruritic maculopapular rash starting on palms and soles (often the first clinical sign). Blisters and ulcerations in severe cases. Chronic GVHD can produce scleroderma-like skin hardening
- GI distress: Nausea, anorexia, profuse watery diarrhea, abdominal pain. GI bleeding is an ominous sign
- Hepatic: Jaundice, hepatomegaly (enlarged liver), elevated liver enzymes
- Systemic: Fever, chills, muscle aches, profound fatigue
- Three requirements for GVHD: Graft must contain immunocompetent cells, host must have antigens not present in the donor, and host must be unable to destroy the transplanted cells
- Timeline: Acute (<100 days post-transplant) vs. chronic (>100 days)
MT Relevance
- Bleeding precautions are critical: Bone marrow suppression causes thrombocytopenia with high bruising and bleeding risk. Avoid all deep, aggressive, or friction-based techniques
- Strict institutional hygiene protocols: These clients are profoundly immunocompromised. Postpone sessions if the therapist has any active illness, even a mild cold
- Acute stage: Work should be limited to gentle supportive contact — holding or light stroking only
- Nitrile or vinyl gloves may be required by facility protocols
- Skin integrity: Inspect for rashes, blisters, ulcerations, and scleroderma-like changes before treatment. All skin lesions are local contraindications
- Chemotherapy-induced peripheral neuropathy: Numbness or paresthesia from pre-transplant chemotherapy. Assess sensation before applying pressure
Required Actions
- GI bleeding (blood in stool, melena, or hematemesis) is an ominous sign requiring immediate medical attention — do not treat
- Fever indicates active immune response — systemic contraindication. Do not treat
- Coordinate with the medical team before initiating any massage program for a GVHD patient. Treatment must be integrated with the transplant team's care plan
Key Takeaways
- Bleeding precautions are critical: bone marrow suppression causes thrombocytopenia with high bruising risk.
- Follow strict institutional hygiene protocols. Postpone sessions if the therapist has any active illness.
- Acute stage work is limited to gentle supportive holding or light stroking only.
- GI bleeding is an ominous sign requiring immediate medical attention.
- Severe acute GVHD has survival rates as low as 5%. The maculopapular rash on palms and soles is often the first clinical sign.